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 Table of Contents  
REVIEW ARTICLE
Year : 2019  |  Volume : 8  |  Issue : 1  |  Page : 6-10

Management of oral candidiasis: A review


1 Total Care Dental Clinic, Calicut, Kerala, India
2 Saveetha Dental College, Chennai, Tamil Nadu, India

Date of Submission07-Feb-2022
Date of Acceptance08-Feb-2022
Date of Web Publication22-Apr-2022

Correspondence Address:
Suganya Panneer Selvam
Saveetha Dental College, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijhi.IJHI_2_22

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  Abstract 

Candidiasis oral candidosis is one of the most common human opportunistic fungal infections of the oral cavity. The candidia infection may range from nonlife threatening superficial mucocutaneous disorders to invasive disseminated disease involving multiple organs. The treatment after confirmation of the diagnosis should include recognizing and eliminating the underlying causes, such as ill-fitting dentures, history of medications, immunological and endocrine disorders, nutritional deficiency states, and prolonged hospitalization. This pathology has a wide variety of treatment that has been studied until these days. After searching the latest articles about the treatment of candidiasis, it can be concluded that the incidence depends on the type of candidiasis and the virulence of the infection. Although nystatin and amphotericin b are the drugs used the most locally, fluconazole oral suspension is proving to be a very effective drug in the treatment of oral candidiasis. In certain high-risk groups, antifungal prophylaxis reduces the incidence and severity of infection. The prognosis is good in the great majority of cases.

Keywords: Candidiasis, ill-fitting denture, opportunistic infection


How to cite this article:
P K I, Selvam SP. Management of oral candidiasis: A review. Int J Histopathol Interpret 2019;8:6-10

How to cite this URL:
P K I, Selvam SP. Management of oral candidiasis: A review. Int J Histopathol Interpret [serial online] 2019 [cited 2022 Oct 7];8:6-10. Available from: https://www.ijhi.org/text.asp?2019/8/1/6/343726




  Introduction Top


The malady of oral thrush or candidiasis has been known to occur in people for more than 2,000 years. These lesions are caused by the yeast Candidia albicans. Candidia albicans is one of the components of normal oral microflora.[1],[2] An increasing incidence of the infection is associated with some predisposing factors [Table 1]. Oral candidiasis is one of the most common clinical features of those patients infected with HIV, and this manifestation is seen in up to 90% of individuals infected with HIV.[3] Clinically, there are a number of different types of oral candidiasis [Table 2]. Therefore, the choice of therapy is guided by the type of candidiasis.

Factors Predisposing for Oral Candiasisis[4]

Table 1: Factors predisposing for oral candidiasis

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Table 2: Types of oral candidiasis

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Types of Oral Candidiasis


  Pseudomembranous Candidiasis Top


This form of oral candidiasis is classically present as acute infection, though the term chronic pseudomembranous candidiasis has been used to denote recurrence cases. On the oral surfaces, the superficial component is present as white or whitish yellow creamy confluent plaques resembling milk curd or cottage cheese [Figure 1]A.
Figure 1: Clinical picture of acute pseudomembranous candidiasis (A), acute atrophic candidiasis (B), denture-induced candidiasis (C), and angular cheilitis (D)

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  Denture Stomatitis Top


It is chronic inflammation of the mucosa that is typically restricted to the denture-bearing area, which is seen in association with candidiasis.[5]


  Angular Cheilitis Top


This form of candidiasis usually manifests as erythematous or ulcerated fissure, typically affecting unilaterally or bilaterally the commissures of the lip.[6]


  Medium Rhomboid Glossitis Top


Median rhomboid glossitis appears as central papillary atrophy of the tongue and is typically located around the midline of the dorsum of the tongue.[7]


  Histopathology of Oral Candidiasis Top


  • A. Fragment showed parakeratosis, acanthosis, exocytosis of polymorphonuclear leukocytes, permeating corneal layer of the epithelium, and moderately diffused perivascular inflammatory infiltrate [Figure 2]A.


  • B. Periodic acid Schiff stain showed the presence of Candida sp.hyphae permeating the stratum corneum [Figure 2B].
Figure 2: Acanthosis, parakeratosis with inflammatory infiltrate (A) and candidal hyphae on overlying epithelium demonstrated by PAS stain (B)

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  Management of Oral Candidiasis Top


An effective management of oral candidiasis can be achieved by adhering to and following simple guidelines:

  1. Diagnosis through medical and dental history, clinical manifestation confirmed with laboratory tests


  2. Correction of predisposing factors where achievable


  3. Maintenance of proper hygiene of the oral cavity and oral prosthesis, if any


  4. Selection of antifungal therapy based on the severity of infection and the susceptibility of candida species prevalent in that patient



  Antifungal Agents Top


Antifungal agents are available for the treatment of candidiasis. The choice of antifungal treatment depends on the nature of the lesion and the immunological status of the patient. There are three main antifungal drug targets in candida: the cell wall, cell membrane, and nucleic acids [Figure 3].[8]
Figure 3: Mechanism of action of anti-fungal drugs

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Superficial oral candidiasis in generally healthy patients can be treated topically; oral candidiasis in immunocompromised patients should be treated systemically as well as topically. Patients with persisting risk factors and relapsing candidiasis should be treated with antifungals, with the lowest risk of development or*** selection of resistant strains.[4],[9] The different drugs are listed in [Table 3].
Table 3: Treatment of oropharyngeal candidiasis[10]

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  Topical Antifungals Top


Topical antifungals are usually the drug of choice for uncomplicated, localized candidiasis in patients with normal immune function. High levels can be achieved in the oral epithelium with topically administered antifungals. Topically administered miconazole gel is also suitable for the treatment of uncomplicated infections in generally healthy patients.[11] Repeated use of minaconazole, however, may cause a risk of development of azole-resistant strains.[12]


  Systemic Antifungal Agents Top


Systemic antifungals are usually indicated in cases of disseminated disease and/or in immunocompromised patients. Azoles are fungistatic drugs that inhibit the fungal enzyme lanosterol demethylase, which is responsible for the synthesis of ergosterol. Fluconazole and itraconazole are administered orally and they get secreted onto mucous membranes. The oral solution also has a topical effect.[13] The other antifungals, echinocandins, and flucytosine act through the inhibition of D-glucan synthase and DNA / protein synthesis, respectively.[14] Posaconazole is available only as an oral solution and is used in immunocompromised patients and in those resistant to other drugs.[15]


  Alternative Anticandidal Agents Top


Lastly, to mention, a few natural anti-yeast substances can be used as an alternative treatment. These agents with recognized activity against C. albicans included berberine containing plants, caprylic acid, grapefruit seed extract, garlic, probiotics, tea tree oil, and enteric-coated volatile oil preparations containing cinnamon, ginger, oregano, peppermint, and rosemary, propolis, and thyme.[16]


  Prevention of Oral Candidiasis Top


Regular oral and dental hygiene with periodic oral examination will prevent most cases of oral candidiasis; so, it is needed to make the patient aware of oral hygiene measures. Oral hygiene involves cleaning the teeth, buccal cavity, tongue, and dentures. In addition, the use of anti-candidia rinses such as Chlorhexidine or Hexedines can penetrate those areas where the brush does not. Also, there is a need to remove the dentures at night and wash them consciously, leaving them submerged in a disinfectant such as Chlorhexidine.[17]


  Conclusion Top


The total elimination of yeast from the body is also neither feasible nor desirable, considering that yeasts are beneficial to the body when a proper balance exists. The treatment of candida overgrowth does not seek the eradication of candida from the diet or the person, but rather a restoration of the proper balanced ecological relationship between the human and yeast.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published, and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Garcia-Cuesta C, Sarrion-Pérez MG, Bagán JV. Current treatment of oral candidiasis: A literature review. J Clin Exp Dent 2014;6:e576-82.  Back to cited text no. 1
    
2.
Patil S, Rao RS, Manjumdar B, Anil S. Clinicalappearance of oral candida infection and therapeutic strategies. Front Microbiol 2015;6:1391.  Back to cited text no. 2
    
3.
Lalla RV, Patton LL, Dongari-Bagtzoglou A. Oral candiasis: Pathogenesis, clinical presentation, diagnosis and treatment strategies. J Calif Dent Assoc 2013;41:263-8.  Back to cited text no. 3
    
4.
Rautemaa R, Ramage G. Oral candiasis: Clinical challenges of biofilm disease. Crit Rev Microbiol 2011;37:328-36.  Back to cited text no. 4
    
5.
Lund RG, da Silva Nascente P, Etges A, Ribeiro GA, Rosalen PL, Del Pino FA. Occurrence, isolation and differentiation of Candida spp. and prevalence of variables associated to chronic atrophic candidiasis. Mycoses 2010;53:232-8.  Back to cited text no. 5
    
6.
Axéll T, Samaranayake LP, Reichart PA, Olsen I. A proposal for reclassification of oral candidosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;84:111-2.  Back to cited text no. 6
    
7.
Joseph BK, Savage NW. Tongue pathology. Clin Dermatol 2000;18:613-8.  Back to cited text no. 7
    
8.
Cannon RD, Lamping E, Holmes AR, Niimi K, Tanabe K, Niimi M, et al. Candida albicans drug resistance another way to cope with stress. Microbiology (Reading) 2007;153:3211-7.  Back to cited text no. 8
    
9.
Soysa NS, Ellepola AN. The impact of cigarette/tobacco smoking on oral candidosis: An overview. Oral Dis 2005;11:268-73.  Back to cited text no. 9
    
10.
Thompson GR 3RD, Patel PK, Kirkpatrick WR, Westbrook SD, Berg D, Erlandsen J, et al. Oropharyngealcandidiasis in the era of antiretroviral therapy. Oral surg oral med oralpathol oral radiol endod 2010;109:488-95.  Back to cited text no. 10
    
11.
Bensadoun RJ, Daoud J, El Gueddari B, Bastit L, Gourmet R, Rosikon A, et al. Comparison of the efficacy and safety of miconazole 50-mg mucoadhesive buccal tablets with miconazole 500-mg gel in the treatment of oropharyngeal candidiasis: A prospective, randomized, single-blind, multicenter, comparative, phase Iii trial in patients treated with radiotherapy for head and neck cancer. Cancer 2008;112:204-11.  Back to cited text no. 11
    
12.
Rautemaa R, Richardson M, Pfaller M, Perheentupa J, Saxen H. Reduction of fluconazole susceptibility of Candida albicans in Apeced patients due to long-term use of ketoconazole and miconazole. Scand J Infect Dis 2008;40:904-7.  Back to cited text no. 12
    
13.
Pappas PG, Rex JH, Sobel JD, Filler SG, Dismukes WE, Walsh TJ, et al; Infectious Diseases Society of America. Guidelines for treatment of candidiasis. Clin Infect Dis 2004;38:161-89.  Back to cited text no. 13
    
14.
Vandeputte P, Ferrari S, Coste AT. Antifungal resistance and new strategies to control fungal infections. Int J Microbiol 2012;2012:713687.  Back to cited text no. 14
    
15.
Clark NM, Grim SA, Lynch JP 3rd. Posaconazole: Use in the prophylaxis and treatment of fungal infections. Semin Respir Crit Care Med 2015;36:767-85.  Back to cited text no. 15
    
16.
Valera MC, Maekawa LE, De Oliveira LD, Jorge AO, Shygei E, Carvalho CA. In vitro antimicrobial activity of auxiliary chemical substances and natural extracts on Candida albicans and Enterococcus faecalis in root canals. J Appl Oral Sci 2013;21:118–23.  Back to cited text no. 16
    
17.
Kassaify Z, Gerges DD, Jaber LS, Hamadeh SK, Aoun Saliba N, Talhouk SN. et al. Bioactivity of Origanum syriacum essential oil against Candida albicans. J Herbs Spices Med Plants 2008;14:185-99.  Back to cited text no. 17
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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  In this article
Abstract
Introduction
Factors Predispo...
Types of Oral Ca...
Pseudomembranous...
Denture Stomatitis
Angular Cheilitis
Medium Rhomboid ...
Histopathology o...
Management of Or...
Antifungal Agents
Topical Antifungals
Systemic Antifun...
Alternative Anti...
Prevention of Or...
Conclusion
Factors Predispo...
References
Article Figures
Article Tables

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